Using Telehealth to Adapt Service Delivery for Children during the COVID-19 Pandemic

Staff from the Institute for Human Development (IHD) at Northern Arizona University have provided evaluations for children with developmental disabilities (DD) in Arizona communities for over 20 years. These evaluations include Developmental Evaluations, Augmentative and Alternative Communication (AAC) evaluations, and evaluations for eligibility for Part C of IDEA (Individuals with Disabilities in Education Act) early intervention services. Following the evaluations, IHD staff may provide interventions that consist of training, coaching, and direct services. Evaluations and follow-up interventions have historically been provided in homes, the community, or a clinic setting by interdisciplinary teams that consist of two or more of the following: Occupational Therapists, Speech-Language Pathologists, Physical Therapists, Educational Psychologists, or Developmental Specialists. During the COVID-19 pandemic and subsequent need for physical distancing, three IHD programs modified the standard in-person evaluation process. Staff from the Growing in Beauty Partnership Program (GIBPP, the Navajo Part C program), the Interdisciplinary Training Clinic, and the Augmentative Communication Evaluation and Training Program conducted evaluations through televisits that consisted of parent interviews and observations of the child performing specific tasks. GIBPP staff modified intervention methods for children birth to three years old already on caseload at the time of the pandemic outbreak, providing coaching to families through telepractice. For AAC evaluations, AAC equipment was delivered to the family before the evaluation. In reporting the adaptation of our processes due to the COVID-19 pandemic, we used the expanded Framework for Modifications and Adaptations (FRAME) developed by Stirman et al. (2019). Using the eight components of the FRAME, we described the processes developed and undertaken to implement telepractice in these three programs at IHD during COVID-19. The article includes a summary of the decision-making processes used to determine which clients to include or exclude. The decision- making process included such criteria as the child’s characteristics and capabilities, technology access of the parents, and equipment needs. The outbreak of COVID-19 provided opportunities for practical experiences in the utilization of telepractice in a variety of settings and with a diverse clientele with developmental disabilities. These experiences informed diagnostic and intervention telepractice efforts that are potentially efficient, beneficial, and sustainable over the long-term. Steps to guide the criteria for inclusion of families in telepractice, the operational procedures for evaluation and intervention, and the contextual factors that influence quality and fidelity are further explained. The role of telepractice in reducing and accentuating health disparities are discussed based on our experiences in rural and tribal communities. This information will help to guide other practitioners working in similar settings with similar populations